Cognitive sequelae of severe malaria with impaired consciousness

被引:125
作者
Holding, PA
Stevenson, J
Peshu, N
Marsh, K
机构
[1] KEMRI, CRC, Ctr Geog Med Res, Kilifi Unit, Kilifi, Kenya
[2] Univ Southampton, Dept Psychol, Southampton SO17 1BJ, Hants, England
[3] John Radcliffe Hosp, Nuffield Dept Clin Med, Oxford OX3 9DU, England
基金
英国惠康基金;
关键词
malaria; cognitive development; cognitive sequelae; childhood encephalopathy; Kenya;
D O I
10.1016/S0035-9203(99)90368-1
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Although cerebral malaria is the most common acute encephalopathy arising in children in Africa little is known of its effect upon the longer-term cognitive development of survivors. In Kenya, we compared the performance of 87 survivors of severe malaria with impaired consciousness to matched community controls on a wide range of tasks, not less than 42 months post illness episode. The presence of cognitive impairment was then related to both the pattern of symptoms at the time of the acute illness and the presence of gross neurological impairment on discharge. Significant group differences were found in areas of cognitive functioning suggestive of widespread impairment in the development of the ability to initiate, plan and carry out tasks (the executive functions). On tasks of more discrete cognitive skills (information processing) there were no significant group differences, although impaired performance was found more frequently in the severe malaria group. The odds ratio associated with the development of cognitive impairment following severe malaria with impaired consciousness was found to be 4.48 (95% CI 1.22, 16.47). A combination of 4 signs (coma, hypoglycaemia, seizures, and absence of hyperpyrexia) proved to have greater accuracy than the presence of gross neurological sequelae in predicting cognitive impairment (95% vs 93% specificity, 67% vs 58% sensitivity).
引用
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页码:529 / 534
页数:6
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